Author: NC Oral Health Collaborative

COVID-19 has impacted virtually every aspect of human life for the past two years. From retaining steady employment and income to maintaining preventive medical care, healthy habits, and more, things got a bit more difficult for most everyone, and a whole lot harder for many.

COVID-Oral Health Connection

Earlier in the pandemic, we published an initial overview of the ways that the virus has impacted oral health. As we enter 2022, with a hopeful light at the end of the tunnel, we are taking another look at the connection between COVID-19 and oral health to break down the many ways the pandemic impacts our mouths.

Here’s a brief review of what we know so far.

Loss of Taste and Smell

From the beginning of the pandemic, loss of taste and smell have been prominent symptoms of COVID-19. As the first recognized oral manifestation of the virus, loss of taste was an early indicator of infection, even as testing and other precautionary measures were still ramping up.

Loss of taste and smell, which are typically grouped together in part due to the similar nature of the two senses, continue to be significant issues for many diagnosed with COVID-19. They are also often among the longer-lasting impacts of the disease. Like many COVID-19 symptoms, however, people who have contracted the virus have a wide range of experiences with the loss of these senses.

In some cases, loss of taste and smell lasts a short period of time before returning to normal, and many who contract COVID-19 don’t lose these senses at all. But in others, sensory loss lasts months, and there are even some cases where the loss of taste and smell seems to be permanent.

Treatment for COVID-related Loss of Taste and Smell

“There are frustratingly few interventions” to treat taste and smell loss, according to a Journal of the American Medical Association (JAMA) commentary. One of the only successful options is olfactory (smell) training. This treatment basically involves regularly smelling a variety of scents. While the mechanisms that make this remedy work are still largely unknown, it has demonstrated a significant level of success.

Physicians and researchers at Thomas Jefferson University Hospital are currently developing another potential treatment: topical platelet-rich plasma (PRP). PRP, which is commonly used for injuries like tennis elbow and muscle pulls, has shown promising results in early trials for treatment of loss of taste and smell.

Dry Mouth and Oral Lesions

While loss of taste and smell were among the first widely known symptoms of the virus, dry mouth has become the most common oral manifestation of COVID-19, present in 43 percent of cases.

Dry mouth has the potential to lead to or intensify existing oral disease. Saliva is an oral health powerhouse — it helps defend against decay-causing acids and bacteria. With less saliva, people who contract COVID-19 and experience dry mouth are at greater risk of tooth decay and gum disease.

Researchers have also found a significant correlation between COVID-19 infection and oral lesions. Again, the exact mechanisms connecting the virus and the oral manifestation are not clear, and there is a wide variety of types of lesions that have been documented. Ranging from canker sores to herpes-like sores, oral thrush, and more, these lesions were found in 20.5 percent of patients in a study surveying 2,491 cases of COVID-19.

Treatment for Dry Mouth and Oral Lesions Due to COVID-19

According to the Mayo Clinic, dry mouth treatment options include:

• Stay hydrated
• Reduce caffeine intake
• Don’t use alcohol-based mouthwashes
• Stop using tobacco
• Use a humidifier at night
• Use an over-the-counter dry mouth mouthwash

Oral lesion symptoms associated with COVID-19 vary widely. Minor canker sores generally clear up on their own with no treatment, and there are a variety of mouth rinses and topical products available for more persistent sores. For other symptoms like oral thrush, antifungal medicines may be necessary. Because of the wide variation in lesions, the best approach if you are experiencing these symptoms is to consult your dentist.

Understanding COVID-19 and Its Oral Manifestations

To say the least, COVID-19 is an incredibly confusing virus. The list of potential effects is seemingly endless and disconnected, ranging from flu-like symptoms like fever, cough, and sore throat to:

• Shortness of breath, and difficulty breathing
• Headaches
• Loss of taste and/or smell
• Oral lesions
• Brain fog
• Pink eye, light sensitivity, and sore or itchy eyes
• Rashes
• Swollen or discolored extremities
• And more

Some of the most prominent symptoms are very similar to the flu, suggesting that COVID-19 is a respiratory disease. But researchers are continuing to find evidence indicating that COVID-19 might be a vascular virus – a disease of the blood vessels.

Looking at COVID-19 as a blood disease can help demystify the variety of seemingly disconnected symptoms. In the dental community, we are familiar with the important role of blood vessels in the mouth-body connection. With COVID-19, blood vessels could be the link between stroke-like brain impacts, respiratory problems, and oral manifestations.

COVID-19 and Oral Health Equity

Beyond direct connections between COVID-19 and the mouth and the nearly endless list of symptoms associated with the virus, there is another long list of impacts that make their way back to our mouths. Nearly every social determinant of health has been exacerbated during the COVID-19 pandemic, and they all have oral health repercussions.

Prior to the pandemic, the U.S. poverty rate was at its lowest point since 1959. Despite supplemental programs to offset income loss early in the pandemic, poverty rates for adults and children alike have increased. Many people struggled (and continue to struggle) to get enough food, retain steady employment, and maintain stable housing — all of which have known links to oral health and overall health.

The bottom line: Outside of the dental office, it has been much harder for millions of people to maintain good oral health habits during the pandemic.

Inside the dental office, things also became harder when the pandemic hit.

• There is a plethora of anecdotal evidence from dentists across the country who have seen more patients with stress-induced cracked teeth.
• Fear of seeking care due to possible COVID-19 exposure continues today, putting people at risk of more extensive treatment needs down the road.
• The widening income gap and shaky employment situations have left many without the insurance necessary to maintain regular preventive appointments.
• Dental staffing shortages, a problem before COVID-19, have become more severe during the pandemic, especially among hygienists and assistants.

Oral Health & COVID-19: Where Do We Go from Here?

The list of connections between COVID-19 and oral health could go on and on. For example, dental researcher Faleh Tamimi is leading a study of similarities between COVID-19 and periodontal disease co-morbidities, finding that people with COVID-19 and gum disease are 3.5 times as likely to be admitted to an ICU and 4.5 times as likely to be put on a ventilator. In the months and years ahead, we’ll continue to keep a close eye on this and other research exploring the link between COVID-19 and oral health.

At the end of the day, however, one thing is clear: the many ways COVID-19 impacts oral health continue to be significant.

The pandemic could, and should, be an opportunity as well. With so many in need, and with so much focus on health care, we have an incredible opportunity to look at structural changes to dramatically increase access to care.

NCOHC and our incredible coalition of partner organizations and advocates are taking strides to map out the future of oral health care – a. future that includes everyone, everywhere. Learn more about current initiatives and ways you can get involved today at oralhealthnc.org/nc4change.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

The NCOHC team recently had the rare opportunity to venture out of our homes and wipe the dust off our desks. With masks in hand, we made our way to our Foundation for Health Leadership & Innovation office to meet Mary Otto, journalist and author of the critically acclaimed book “Teeth” while she was here in North Carolina.

Otto is a health care reporter and a leading voice in oral health journalism. If you haven’t read “Teeth,” the book is an eye-opening account of the pervasive inequities that exist in oral health care and their devastating impacts.

Dental offices are team operations. Take away your dentist or hygienist and the work will grind to a halt. The same goes for dental assistants. They are vital — but often underappreciated — members of the dental team. To learn more about what dental assistants are and the roles they fill, we sat down for a conversation with dental assistant and educator Kati Garrett.

Garrett has worked as a dental assistant, a job she pursued because of her passion for improving oral health, for more than a decade. On top of her day job, Garrett also oversees Catawba Valley Community College’s (CVCC) dental assisting program.

“It’s nice to see the difference you can make working in dentistry. I saw growing up how much dental health can affect you as an individual,” she said. “Both of my parents had dentures, my grandparents had dentures. It wasn’t something stressed for me growing up. But the older I got I realized just how important it is.”

What is a Dental Assistant?

Dental assistants are important members of any dental team, primarily tasked with helping dentists and hygienists perform their jobs efficiently. Assistants fill a variety of roles, however, ranging from directly assisting dentists and hygienists chairside to sterilizing equipment, performing infection control duties, helping patients navigate insurance and billing, working as office managers, and more.

“The role a dental assistant fills can vary—they play a lot of different parts in the dental office,” said Garrett. “When you are trained as a dental assistant you are trained to sit chairside and directly help a dentist or hygienist get their job done quicker and more efficiently. But dental assistants also work as office managers, sterilization technicians, treatment plan coordinators, insurance gurus, you name it.”

One thing that Garrett loves about dental assisting is the opportunities that exist for growth and movement. With all the different jobs that assistants can do in a dental office, there is something for everyone. That versatility — from finances and insurance to everyday logistics — also means that assistants play an important role in keeping an office functioning like a well-oiled machine.

“I think I could probably speak for every dental assistant when I say this. If you keep your dental assistants happy, you can get a lot of work done,” said Garrett. “Dental assistants are so much a part of keeping things rolling in the dental office that if you treat them well and make sure their hard work is appreciated, they can really keep the dental office moving.”

How Do You Become a Dental Assistant?

There are several paths to becoming a dental assistant, and a variety of programs train dental assistants at various levels.

“There are accredited schools – you come out of those as a Certified Dental Assistant,” said Garrett. “There are also a ton of proprietary schools that offer 8-week or 12-week courses, but the education can also be as simple as receiving all of your training chairside. You’ll have to get certifications of course, but as far as learning the skills of a dental assistant, that can be done in the dental office, taught by your dentist.”

The program that Garrett oversees at CVCC offers a new path to becoming a dental assistant, in between the shorter 8-12-week courses from proprietary schools and the longer accredited programs. Students who complete CVCC’s 6-month dental assisting program can apply to take the National Entry Level Dental Assisting (NELDA) certification, a new certification from the Dental Assisting National Board (DANB).

NCOHC’s associate director, Crystal Adams, launched the NELDA certification program when she worked for CVCC. She said that her hope is for the program to offer an expedited path to dental assisting that includes a more comprehensive and accountable baseline education compared to other, faster programs.

In North Carolina, dental assistants are classified as “DA I” or “DA II” depending on their education and training. A DA II can take the DANB examination to become a Certified Dental Assistant. In some states, dental assistants are registered with Dental Boards for consumers and providers to confirm their credentials; however, North Carolina does not. Dental assistant education and training requirements can be found on the North Carolina State Board of Dental Examiners website.

While there are numerous routes to becoming a dental assistant, graduating from a Commission on Dental Accreditation (CODA) Dental Assistant Program allows a dental assistant the most comprehensive education and training for the dental field. These programs are offered at North Carolina Community Colleges throughout the state and a list of programs can be found on DANB’s website.

What Else Should I Know About Dental Assisting?

“I think that we should probably hold proprietary schools more accountable,” said Garrett.

Garrett said that more attention should be paid toward the institutions training assistants, ensuring that they are providing quality education.

“If you work for a great dentist, you are shown appreciation and know that your job is important,” said Garrett. “That has certainly been the case for me, but sometimes dental assistants are forgotten.”

Overall, Garrett thinks that dental assisting is a great profession with lots of opportunities. She also said, however, that they are sometimes underappreciated and underpaid.

“When I came in as an assistant 10 years ago, I was making $11.50 an hour,” she said. “Man have I grown since then, but there are plenty of dental offices out there where that pay range is still the case.”

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

“Managed Care” is transforming Medicaid in states across the country. In many cases, including in North Carolina, oral health is not included in the programs that promise a shift toward value-based care. As North Carolina approaches the next phase in its Managed Care program, could, and should, oral health be included? NCOHC’s newest partnership plans to convene stakeholders across the state to find out.

A collection of state-run programs, Medicaid has traditionally been operated on a “fee for service” basis, in which government agencies across the country pay out claims for health services based on volume. For decades, this model has prevailed in both medical and oral health care.

The Shift to Managed Care

Recently, however, state-administered Medicaid programs have begun to embrace an alternative payment model. In its simplest form, “managed care” turns management of Medicaid health plans over to private insurers, paying them a set rate per patient to deliver all services necessary to keep beneficiaries healthy. Ideally, managed care supports a shift to “value-based care,” in which reimbursement policies incentivize prevention and improved patient outcomes.

Managed Care and Oral Health

Unfortunately, the national shift to Medicaid managed care has in many cases reinforced long standing “siloes” that artificially separate medical care from oral health care. In North Carolina, for instance, the state’s Medicaid program transitioned to managed care on July 1, 2021, but the initial launch only included primary care and behavioral health services. As seen in various other states, oral health care was essentially “carved out” of the new system.

With the health of so many at stake and the investment so significant, we at the North Carolina Oral Health Collaborative (NCOHC) felt it critical to ensure that consideration of the potential shift to oral health managed care includes the voices and perspectives of diverse stakeholders. While the consensus among North Carolina providers and policymakers seems to be that oral health care will be integrated into Medicaid managed care in the future, we hope that collective engagement will help inform and support the potential transition as seamlessly and effectively as possible.

Oral Health Transformation Initiative

To that end, NCOHC is partnering with the North Carolina Institute of Medicine (NCIOM) on a Medicaid Oral Health Transformation Initiative, designed to evaluate best practices and make recommendations for oral health’s potential inclusion in NC Medicaid Managed Care efforts.
The two-year, three-phase project will be led by multi-disciplinary, cross-sector stakeholders and Task Force members engaged in oral health and health care across North Carolina.

The Task Force will draw upon a systematic literature review and key informant interviews with those in and outside North Carolina. Recommendations will be compiled in a final report to be delivered to policymakers and legislators as they consider a potential transition to Medicaid managed care for oral health. This work will be completed just in time for the 2024 expiration (and subsequent renewal) of the federal 1115 Demonstration Waiver that paved the way for the current iteration of North Carolina’s Medicaid Managed Care.
 

 
 

To learn more, please visit our Oral Health Transformation Initiative page.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

Sometimes, the best prevention is a layer of protection. Take a baking sheet out of the oven and you’ll probably protect your hand from the heat with an oven mitt or towel. Go out in the rain and a raincoat or umbrella is your best bet if you want to stay dry. In this blog post, we’ll explain what dental sealants are — and how they function in a similar way.

Protecting our teeth is essential. Dental sealants add a layer of protection to your teeth, helping ward off decay-causing acids, sugars, and bacteria. They are an especially effective option for children, in part because insurance often covers them up to a certain age. Sealants are about as simple as they sound, and they are a great way to keep your teeth healthy and protected from cavities. When it comes to prevention, sealants are a fantastic option.

How Do Sealants Work?

Dental sealants act as coatings, filling in any pits or grooves on a chewing surface to form a protective layer over a tooth’s enamel.

Typically, sealants are applied to the chewing surfaces of molar teeth, but they can be applied elsewhere as needed. For example, sometimes sealants can be placed on the back surface of a front tooth that has exceptionally deep grooves.

Sealants may be applied by a dentist or, depending on the specific state’s laws, a dental hygienist or dental assistant. In some states, physicians and other medical staff may also apply dental sealants.

What are Sealants Made of?

Sealants are typically applied in the form of a liquid resin that becomes hard when cured. If you ever had a sealant applied, a cavity filled, braces attached, or any similar dental procedure, you may remember your dentist or hygienist using a tool that almost looks like an electric toothbrush without any bristles.

That tool is what “cures” the liquid sealant, leaving behind a rigid, protective layer.

Do Sealants Work?

Yes, sealants are very effective. According to the CDC, dental sealants can prevent 80 percent of cavities for two years. They have been proven to protect against 50 percent of cavities for up to four years, and there is evidence that they can work for up to nine years.

It is easy for a provider to tell when a sealant either falls off or is worn away, and fortunately they are easy to replace!

Are Dental Sealants Safe?

It is important to note concerns about BPA entering a patient’s system from dental sealants. Fortunately, several studies have been conducted to measure BPA exposure from sealant application, and the widespread consensus is that they are completely safe.

Some BPA may be detectible in a patient’s saliva hours after a sealant is applied, but no associated increase in BPA levels has been detected in patients’ blood at any time post-sealant application.

BPA can imitate a person’s naturally produced hormones, causing an array of health issues. It is an important environmental concern, but fortunately, dental sealants are not a source for concern.

In fact, breathing in dust or touching a receipt will expose a person to much more BPA than a dental sealant application.

How Much Do Sealants Cost?

Some dental plans cover sealants, especially for children. For patients without insurance or with insurance that doesn’t cover sealants, they typically cost between $30 and $75 per tooth. This is a lot more affordable compared to the price of a filling ($150-$450) or other more invasive treatment.

The cost can vary by provider, insurance, and material used, so it is important to ask your dentist to get a better idea of the price tag for dental sealants.

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

The year is 2021. At the turn of the century, kids trading playing cards could never have imagined that in 20 short years they would be able to walk among the Pokémon printed on their cards, finding creatures in their backyards and battling other trainers on street corners around the world.

Picture of Pokemon cards (left) by Minhimalism

Scientists haven’t managed to actually bring fictional animals to life, but technological advances in Augmented Reality (AR) have made it possible to merge digital environments with the real world. And while AR is already used for entertainment purposes, developers are finding new and innovative ways to incorporate the technology into a wide variety of work settings.

For example, The Weather Channel has used AR technology to bring and extra dimension to newscasts about extreme weather events like hurricanes.

 
The world of medicine is no exception—researchers and developers see a bright future for AR technology in a variety of medical settings.

Parth Patel, a UNC Chapel Hill neuroscience student who has studied AR, specifically exploring its potential medical uses, said, “This modern piece of technology is slowly becoming common in various dental practices, particularly oral surgery and prosthodontics.”

“AR allows a dental practitioner to view a three-dimensional model in front of them while operating on the patient,” said Parth. “This reduces any error that may occur glancing back and forth between the screen and the patient.”

Parth also mentioned the potential for AR technology to enhance dental education, allowing students to truly see what a procedure looks like before operating on a patient.

Parth sees a potential for AR-informed dentistry to increase access to care. He said that the technology can allow dental professionals to perform more procedures outside of the dental office. Even in a traditional setting, using AR technology to guide procedures could significantly increase the efficiency of a dentist’s workflow.

“Though literature is limited on AR, results of existing research are very promising,” said Parth. “AR is likely a form of technology that we will see commonly at the dentist’s office in the coming years.”

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

2021 was quite the year!

Of course, we could write an entire book about the ways that COVID-19 continues to impact people’s daily lives, not to mention the incredible strain that the pandemic is still placing on all facets of our health care system. Back in January, we certainly had high hopes that we were beginning to see a light at the end of the tunnel. But the struggle continues.

Fortunately, the shadow of COVID-19 didn’t stop our progress. The NCOHC team and our incredible network of partners and fellow advocates had a productive year, and North Carolina was able to take significant steps toward greater access and equity in oral health care.

Legislative Progress

Early in the year, Governor Roy Cooper signed Executive Order 193, authorizing dentists to join the COVID-19 vaccination effort.

In July, Session Law 2021-95 was enacted, codifying teledentistry in the North Carolina Dental Practice Act and authorizing hygienist-administered local anesthesia. The law also aligned regulations, allowing hygienists to deliver preventive care more efficiently in community settings. No less significant, for the first time, Federally Qualified Health Centers (FQHCs) were recognized in state law.

More recently, the state budget passed in November included an extension of the North Carolina Medicaid for Pregnant Women (MPW) program, expanding health benefits — including those for oral health — to birthing parents up to one year postpartum.

We are thrilled to have been a part of a productive 2021 legislative session. This year was certainly a testament to the power of collaboration. If we were to thank everyone involved individually, this blog post would easily turn into a novel. The North Carolina Dental Society, however, deserves recognition for its partnership in co-creating lasting change. So does Senator Jim Perry, who filed Senate Bill 146 (now Session Law 2021-95) in the North Carolina Senate and worked hard to ensure its passage.

Oral Health Day 2021

This year’s Oral Health Day was a spectacular success!

Rear Admiral Timothy L. Ricks DMD, MPH, FICD, Assistant Surgeon General and Chief Dental Officer of the United States Public Health Service (USPHS), joined NCOHC to give the keynote address. RADM Ricks covered everything from what the USPHS is and the work that the agency does, to the state of COVID-19 progress on equity in the dental world, and more.

Amy Martin, DrPH, MSPH, who chairs the Department of Stomatology and directs the Division of Population Oral Health at the Medical University of South Carolina (MUSC), also joined Oral Health Day to discuss the innovative ways that MUSC is approaching community-based oral health care in South Carolina.

Finally, William Donigan, DDS, MPH, and Melissa Boughman, RDH, spoke about Kintegra Health’s experience employing patient navigators. Kintegra Health has been on the forefront of innovations in care coordination and case management, and Dr. Donigan and Ms. Boughman provided great insight into the benefits of these care models.

Staff Growth

Have we said that 2021 was a busy year? With all the work on NCOHC’s plate, it was past time for the team to grow. This year, we welcomed two new full-time staff members — Sarah Heenan and Crystal Adams.

Sarah joined the NCOHC team back in April as our new program coordinator, and Crystal came onboard in September as our associate director.

And So Much More…

The reality is, there are just too many highlights to fit into a single blog post. Check out some of the videos we published this year, especially this one about the NCOHC Teledentistry Fund and this one, where we envision a “more perfect oral health ecosystem.” And don’t forget to peruse a year’s worth of updates, storytelling, and analysis on our blog!

No Slowing Down

While 2021 was a year to remember, we are sure that 2022 will bring even more advances in oral health access in equity across North Carolina. NCOHC has some big news to share very soon, and we are so excited to include you in the next phase of the work!

NCOHC, a program of the Foundation for Health Leadership & Innovation, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. To stay up-to-date and get involved, join us today as a North Carolinian for Change.

Happy holidays from the NCOHC Team!

We hope that you are having a festive, relaxing holiday season. Here’s what our team is up to:

What is your favorite part of the holidays?

Zach: Oh, where to start? There are so many things, so I’ll just pick one. I love the lights. We’re fortunate to live in a neighborhood where people get very into the holidays, and it’s fun to drive around and see what folks have come up with. My husband and I also like to decorate, and we’ve (maybe) gone a little overboard this year :) 

Sarah: My favorite part of the holidays is the overall joyfulness I feel when I am spending time with the people I love so dearly. The season brings a lot of comfort and coziness for me with decorations, smells, gifts, and dedicated time to spend with those I love.

Crystal: When I think about the upcoming holidays drawing near, excitement fills my heart. I will spend quality time with my family and friends in a few short weeks. Throughout the year, everyone is so busy, but during the holidays, everyone will slow down enough to enjoy some memorable moments. It is a time of year I will have all three of my boys under one roof for a whole week. Then the night before Christmas, my extended family and friends will gather at my sister’s house. It is a time that I catch up with my aunts, uncles, cousins, sisters, nieces, nephews and friends. The highlight of the night is when Santa makes a surprise visit before he heads out to deliver the gifts to all the children.

Brady: I love taking time to relax, rest, and gather with family and friends. I also really enjoy getting a Christmas tree each year. My dad is allergic to pine, so we grew up with an artificial tree. Now, every year my fiancé and I get a real tree, and I love the smell of pine throughout our house!

Do you have any special family traditions or events?

Zach: My husband and I like to choose a special cause to donate to every year, and it’s fun to find something we’re both passionate about where we can help.  

Sarah: My sister’s birthday is Christmas Eve; she lives her whole year looking forward to her birthday, so we celebrate her on Christmas Eve- it’s my favorite day of the year. Her joy is infectious and on her birthday, her cup overflows with so much joy — it’s truly the best.

Crystal: A holiday tradition that I cherish is going to my dad’s house for breakfast on Christmas morning. On Christmas morning, everyone wakes up to Santa’s surprises. After everyone discovers what Santa left for them, my four sisters and their families, along with my family (a total of 22), travel to my dad and stepmother’s house. We go in our pajamas and, of course, freshly brushed teeth. My dad demonstrates his cooking skills in front of all the kids and grandkids by throwing eggs up in the air to flip them to the other side. The kids love it! I love this time because we spend quality time with my family while enjoying fantastic food.

Brady: My favorite tradition is Christmas morning breakfast with my family—actually, the entirety of Christmas day. The whole family gets together on Christmas morning for steak and eggs. I try and eat a mostly vegetarian diet throughout the year, so the Christmas morning “cheat day” is extra special. Then, in the evening we all gather again at my grandparent’s house for a very eclectic Christmas dinner. We like to joke that anyone my grandmother happens to meet that week at the grocery store is invited. It’s an all-around great time with family and friends, and I always seem to meet someone new!

What are you looking forward to in the new year?

Zach: I’m excited about opportunities to continue advancing access and equity in oral health care across North Carolina. I’m really passionate about the work we’re doing at NCOHC and FHLI, and there’s a lot of positive momentum right now. I’m also hopeful that more people will get vaccinated! 

Sarah: I am looking forward to a year full of more and more hugs! As I think about the new year and what that means to me, I reflect upon the lessons and gifts of the previous year while being hopeful for joy-filled days ahead. In 2022, I am really looking forward to my upcoming wedding and spending those special moments with my partner and those who love us!

Crystal: NCOHC had a lot of success creating system change for oral health care access in 2021. As a new addition to the NCOHC team, I am looking forward to working on various initiatives and seeing what NCOHC accomplishes in 2022. Personally, I am excited to see my son, Chase, graduate high school in 2022 and see where life takes him.

Brady: I have so much to look forward to in 2022, both in my personal and professional life! I’m excited to see the ways that NCOHC can leverage the work we did this year to create more positive change for folks across North Carolina.

On Nov. 18, Governor Roy Cooper signed the 2021 North Carolina state budget into law, the first budget the state will have since 2018.

There are many reasonable provisions in this year’s budget — thanks to American Rescue Plan funds, an historic amount of money has been allocated to improve the lives of North Carolinians. There are other provisions that were unfortunately left out as well, most importantly from a public health perspective being full Medicaid Expansion.

At NCOHC, our staff has been focused on one particular provision: expansion of the Medicaid for Pregnant Women program to one year postpartum (after birth).

Earlier this year, one of NCOHC’s fantastic interns, Hannah Archer, wrote a policy brief outlining the benefits of expanding postpartum Medicaid services and analyzing its political feasibility.

The policy was originally proposed as a standalone bill by Senators Jim Burgin, Joyce Krawiec, and Kevin Corbin. It goes without saying that NCOHC was thrilled to see the policy incorporated into the 2021 budget.

The Details

The postpartum Medicaid service expansion will go into effect on April 1, 2022. After that date, North Carolinians with incomes up to 196 percent of the federal poverty level will be able to access Medicaid services for the duration of pregnancy and one full year after giving birth.

The policy, as laid out in the 2021 budget, is set to expire on March 31, 2027. NCOHC is fully confident that the benefits of the expansion will speak for themselves over the course of the next five years, and we look forward to working with stakeholders to make the policy a permanent change in the future.

What Comes Next

It will be important to stay tuned as the postpartum Medicaid service expansion is implemented. Currently, the Medicaid for Pregnant Women program includes all medical services, including oral health. Under the current framework, traditional medical services are available for 60 days postpartum, while oral health services end at birth.

The text in the 2021 budget is broad, and language limiting coverage for services “related to pregnancy and to other conditions determined by the Department as conditions that may complicate pregnancy” is removed. This bodes well for oral health’s inclusion in the postpartum expansion (although we would also argue that the negative outcomes that result from a lack of oral health care absolutely fall into the category of conditions that could complicate pregnancy).

The details will be ironed out in the coming months, and we will be sure to keep you up to date on any news as it arises.

NCOHC is a program of the Foundation for Health Leadership & Innovation. To get involved, find out more information, and to stay up to date, head over to NC4Change to sign up for our newsletter and see what events and other opportunities are on the horizon.

On April 8, 2002, Ray Krone was released from prison after serving 10 years for a murder he did not commit.

A decade earlier, a woman’s body was found at the bar Krone frequented. Officers identified Krone as a person of interest, and they took a Styrofoam impression of his teeth to see if they matched bite marks on the victim’s neck.

Krone had distinctly crooked teeth, so after an American Board of Forensic Odontology-certified diplomate testified that Krone’s teeth were a match and he was convicted of the murder, he was dubbed the “Snaggle Tooth Killer.”

Years later, DNA evidence proved that Krone was not involved in the murder – the bite marks were not his.

Bite-mark analysis is used in courtrooms across America, and unfortunately, it is responsible for hundreds of years in wrongful convictions.

“There has been no scientific research that has adequately established basic premises in bite mark comparison work, including whether an examiner can even, with sufficient accuracy, identify a mark as a human-created bite, much less opine on whether a particular set of dentition produced that bite,” said Brandon Garrett, director of the Wilson Center for Science and Justice and the L. Neill Williams, Jr. Professor of Law at Duke University.

The Innocence Project has documented more than 30 instances of people wrongfully indicted or imprisoned in part due to the use of bite-mark analysis.

In total, more than 424 combined years of wrongful incarceration have been served as a result of these convictions.

In fact, bite-mark analysis is so unreliable that it has even been used to convict in cases where bites were later proven to be from animals, not humans.

Garrett mentioned a case in Mississippi in 1995 where Kennedy Brewer was given the death penalty after a bite-mark analysis linked him to marks left on a victim’s body. Years later, a reexamination led to the discovery that the 19 bite marks were actually the result of insect bites, not a human’s teeth. Brewer still served 15 years before his exoneration.

As it stands today, there is little, if any, scientific evidence in support of bite-mark analysis. Beyond that, dentists who serve as forensic odontologists do not have to demonstrate a level of proficiency in the matter at hand: linking marks on a human’s skin to the teeth in someone’s mouth.

“Local courts have even permitted local pediatric dentists and persons with no prior background in forensic work to testify,” said Garrett, adding that even odontologists with decades of experience have made testimony resulting in wrongful convictions. “It is not clear that experience over many years in a technique with unknown reliability makes one better than a novice; the technique may be so unreliable that experience is irrelevant.”

Time to Reconsider Bite-Mark Analysis

The issue of bite-mark analysis is a question of equity and social justice. As NCOHC and our partners work to increase access and equity in oral health care, it is worth considering this social injustice that so closely involves the dental community.

The number of dentists who serve as expert witnesses in the courtroom is small – and the number who provide bite-mark testimony is even smaller. Nevertheless, the impact, especially on those who have been wrongly convicted, is immeasurable.

Learn more: Brandon Garrett recently spoke in depth about bite mark analysis, other social justice issues that stem from forensic sciences, and his book, “Autopsy of a Crime Lab: Exposing the Flaws in Forensics” on the podcast Pod Save the People.

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